The Youth Opioid Recovery Support (YORS) Intervention: An assertive community treatment model for improving medication adherence in young adults with opioid use disorder

项目摘要/摘要： 年轻人受到当前阿片类药物危机的影响不成比例，包括更严重的滞留和 结果与老年人相比。此外，年轻人通常无法获得治疗癌症的药物 阿片类药物使用障碍(OUD)，对于那些这样做的人来说，坚持治疗是一个主要障碍。标准 治疗方法通常不包括了解发展情况的参与战略， 这一特殊人群的保留率和服药依从性。 青年阿片类药物康复支持(YORS)模式是一种创新的综合方法，试图 解决这一弱势青年群体参与治疗的障碍，特别是困难 坚持服药。其成分包括：(1)缓释纳曲酮(XR- (2)让家庭参与协作性治疗规划和监测，重点是 服药依从性；(3)来自治疗团队的果断外展，包括积极跟踪和 通过短信和社交媒体与青年和家庭沟通，促进参与和 坚持服药；以及(4)应急管理，为坚持服药提供激励。尤斯是 目前在调查小组的一项小型试点RCT中显示出非常有希望的结果。 我们建议完善并进行更明确的YORS青少年干预测试 使用R61/R33机构。在R61阶段，我们将组织利益相关者焦点小组，以获得意见和 就潜在的改进提供反馈，同时还对这些潜在的改进进行3个周期的试点测试。 基于R61的准备和干预改进的最终合成，在R33阶段，我们将 通过随机选择N=120名18-26岁的年轻人进行随机对照试验，以测试Yors的疗效 在山地庄园治疗中心(MMTC)使用XR-NTX治疗OUD，无论是精制的Yors 使用XR-NTX进行为期6个月的干预或照常治疗(TAU)。 主要结果将是接受XR-NTX剂量的数量。次要结果将包括阿片类药物 复发、阿片类药物使用天数、首次阿片类药物复发时间、艾滋病毒危险行为、犯罪行为、精神病史 症状、家庭成员痛苦和自我效能感。据推测，YORS的参与者 病情将得到显著更多的XR-NTX剂量，并将表现出不那么严重的阿片类药物使用和 与TAU组的相关行为进行比较。果断的Yors干预有可能 为了提高在这种非常高风险的情况下用药的真实效果和对公共健康的影响， 弱势群体。如果改进的YORS干预被发现是有效的，它将为 未来的工作包括：经济分析，更大的多地点研究，更长的干预持续时间，研究 缓释丁丙诺啡，研究逐步降压至强度较小的干预措施。

Project Summary/Abstract: Young people are disproportionately affected by the current opioid crisis including worse retention and outcomes compared to older adults. Further, young adults typically do not have access to medications for opioid use disorder (OUD), and for those that do, struggles with adherence are a major barrier. Standard approaches to treatment typically do not incorporate developmentally informed strategies for engagement, retention, and medication adherence for this special population. The Youth Opioid Recovery Support (YORS) model is an innovative wrap-around approach that attempts to address barriers to treatment engagement in this vulnerable young adult population, especially difficulties with medication adherence. Its components include: (1) Home delivery of extended release naltrexone (XR- NTX) for OUD; (2) Engagement of families in collaborative treatment planning and monitoring focusing on medication adherence; (3) Assertive outreach from the treatment team including actively tracking and communicating with youth and families by text messaging and social media to promote engagement and adherence; and (4) Contingency management to provide incentives for medication adherence. YORS is currently showing very promising results in a small pilot RCT by the investigative team. We propose to refine and then conduct a more definitive test of the YORS intervention for youth with OUD using the R61/R33 mechanism. In the R61 phase we will conduct stakeholder focus groups to get input and feedback on potential refinements, while also conducting 3 cycles of pilot testing of these potential refinements. Based on the R61 preparation and final synthesis of the intervention refinements, in the R33 phase we will conduct an RCT to test the efficacy of YORS, by randomizing N=120 young adults ages 18-26 seeking treatment for OUD with XR-NTX at Mountain Manor Treatment Center (MMTC), to either the refined YORS intervention or treatment as usual (TAU) for a 6-month course of treatment with XR-NTX. The primary outcome will be number of XR-NTX doses received. Secondary outcomes will include opioid relapse, days of opioid use, time to first opioid relapse, HIV risk behaviors, criminal behaviors, psychiatric symptoms, and family member distress and self-efficacy. It is hypothesized that participants in the YORS condition will receive significantly more XR-NTX doses and will demonstrate less severe opioid use and associated behaviors compared to those in the TAU group. The assertive YORS intervention has the potential to improve the real-world effectiveness and public health impact of medication for OUD in this very high-risk, vulnerable population. If the refined YORS intervention is found to be efficacious, it would set the stage for future work including: an economic analysis, a larger multi-site study, longer intervention duration, study of extended release buprenorphine, and study of step-down to less intensive interventions.